clinical-reasoning

# Clinical Reasoning Skill Use this skill when applying clinical reasoning, evaluating evidence, or making evidence-based clinical decisions. ## When to Use - Applying clinical guidelines to patient cases - Evaluating clinical evidence quality - Translating research to practice - Clinical decision-making under uncertainty - Case-based clinical discussions ## Clinical Reasoning Framework ### 1. Problem Definition - Identify the clinical question - Define patient context (demographics, comorbidities) - Determine urgency and stakes ### 2. Information Synthesis - Gather relevant clinical findings - Organize symptoms and signs - Identify key data points ### 3. Hypothesis Generation Generate clinical hypotheses considering: - Pattern recognition (classic presentations) - Anatomical/physiological reasoning - Epidemiologic likelihood - Pre-test probability ### 4. Evidence Evaluation Assess available evidence: - Study type (RCT, observational, case series) - Sample size and power - Risk of bias - Applicability to patient ### 5. Decision Integration Combine: - Best available evidence - Clinical expertise - Patient values and preferences - Resource considerations ## Evidence Hierarchy | Level | Type | |-------|------| | 1a | Systematic review of RCTs | | 1b | Individual RCT | | 2a | Systematic review of cohort studies | | 2b | Individual cohort study | | 3a | Systematic review of case-control | | 3b | Individual case-control | | 4 | Case series | | 5 | Expert opinion | ## Clinical Guidelines Reference established guidelines: - ACC/AHA (Cardiovascular) - ESC (European Cardiology) - IDSA (Infectious Disease) - ADA (Diabetes) - WHO guidelines ## Uncertainty Handling When evidence is limited: - Acknowledge uncertainty explicitly - Present options with pros/cons - Recommend shared decision-making - Suggest monitoring/ reassessment ## Output Structure ``` Clinical Reasoning: Problem: [clinical question] Hypotheses Generated: 1. [Most likely] - supporting evidence 2. [Alternative] - supporting evidence Evidence Synthesis: - [Relevant guideline/ study] - [Applicability to this patient] Recommendation: - [Primary recommendation] - [Strength of recommendation] - [Alternative options] Monitoring/Follow-up: - [Parameters to track] - [When to reassess] ``` ## Best Practices - Start with clear problem definition - Consider multiple hypotheses - Cite evidence quality - Apply guidelines appropriately - Individualize to patient context - Acknowledge limitations - Plan for reassessment